Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment

Abstract

Background The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction. Methods For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated. Result This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction. Conclusion For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.

Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture

“…The tension band technique is a traditional fixation method for the treatment of patellar fractures. A study by Chang et al showed that tension-band fixation of patellar inferior-pole fractures showed low nonunion rates and reduced loss rates ( Chang et al, 2021 ), but the sample size was small. Tension-band technology can be applied to the fixation with relatively complete cortical bone support and tensile force ( Jang et al, 2019 ).…”

Manejo de fracturas conminutas del polo distal de la patela con asas verticales de alambre: Reporte de casos

“…Existen varias técnicas de fijación descritas en la literatura que buscan preservar el polo inferior de la patela. 9 13 18 19 20 En la literatura más reciente, 21 el uso de alambres verticales y la fijación con placas tipo canasta ( basket plate ) se muestran como los métodos de fijación más confiables.…”

“…There are several fixation techniques described in the literature that seek to preserve the inferior pole of the patella. 9 13 18 19 20 In the more recent literature, 21 the use of vertical wires and basket plate fixation have been shown to be the most reliable fixation methods.…”

Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique

“…Therefore, anatomical reduction with strong internal fixation and early rehabilitation are important for patellar inferior pole fractures. Surgical options for treating patellar inferior pole fractures include tension band wiring (TBW), wiring through cannulated screws, vertical or cerclage wiring, plate fixation, partial patellectomy, and suture anchor (SA) fixation [ 6 ]. Appropriate treatment options vary depending on the degree of comminution and the fracture pattern in patellar inferior pole fractures; previous studies on such fractures were mostly case series and lacked a comparative analysis between each surgical treatment method.…”

“…However, TBW is often insufficient to achieve rigid fixation due to comminuted and small fracture fragments in comminuted inferior pole fractures [ 8 ]. Despite favorable postoperative outcomes after TBW in comminuted patellar inferior pole fractures, pull-out of Kirschner wires (K-wires), reduction loss, and implant irritation have been reported as common postoperative complications [ 6 , 9 ]. Moreover, additional surgeries are frequently necessary for implant removal due to symptomatic implants in patellar fractures treated with TBW [ 6 ].…”